Provider Demographics
NPI:1093865610
Name:DAISY G. ISON, D.M.D., INC.
Entity Type:Organization
Organization Name:DAISY G. ISON, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:GONZAGA
Authorized Official - Last Name:ISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-952-2933
Mailing Address - Street 1:5345 N EL DORADO ST
Mailing Address - Street 2:SUITE
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5872
Mailing Address - Country:US
Mailing Address - Phone:209-952-2933
Mailing Address - Fax:209-952-2271
Practice Address - Street 1:5345 N EL DORADO ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5872
Practice Address - Country:US
Practice Address - Phone:209-952-2933
Practice Address - Fax:209-952-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1615122OtherUNITED CONCORDIA
AL542-42856OtherBLUE CROSS
CAB34120-02OtherDELTA DENTAL
MA1B0K9GOtherBLUE CROSS
PA1615122OtherUNITED CONCORDIA
NJ=========-QABOtherHORIZON HEALTHCARE
AZ=========-00005OtherCORESOURCE